Provider Demographics
NPI:1497137962
Name:DEBRUIN, BRANDI (MS-CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:DEBRUIN
Suffix:
Gender:F
Credentials:MS-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4912 E EL PASO ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-1958
Mailing Address - Country:US
Mailing Address - Phone:918-688-1660
Mailing Address - Fax:
Practice Address - Street 1:1111 N 36TH ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-1809
Practice Address - Country:US
Practice Address - Phone:918-683-4621
Practice Address - Fax:918-683-4002
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77137235Z00000X
OKSP2364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist